Your Team Information

Team information must match application cover sheet. The people listed here should be willing and able to attend the Remembering When Next Steps Workshop. Teams cannot be changed after selections are made.
IMPORTANT:  You will not be able to return to your survey to adjust responses. You may find it helpful to copy the questions, construct your responses in Word and paste them into the survey when you are ready.  

* 1. Community and state/ province your Remembering When team serves:

* 2. Team Leader:

* 3. In the past year, how many Remembering When group presentations have YOU facilitated?

* 4. In the past year, how many Remembering When home visits have YOU completed?

* 5. Tell us how you learned to facilitate the Remembering When program. If you attended a training workshop, provide details.

* 6. Team member #2

* 7. In the past year, how many Remembering When group presentations have YOU completed?

* 8. In the past year, how many Remembering When home visits have YOU completed?

* 9. Tell us how you learned to facilitate the Remembering When program. If you attended a training workshop, provide details.

* 10. Team Member #3 (Optional)

* 11. In the past year, how many Remembering When group presentations have YOU completed?

* 12. In the past year, how many Remembering When home visits have YOU completed?

* 13. Tell us how you learned to facilitate the Remembering When program. If you attended a training workshop, provide details.

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